TY - JOUR
T1 - Determination of the earliest site of ventricular activation in Wolff-Parkinson-White syndrome
T2 - Application of digital continuous loop two-dimensional echocardiography
AU - Windle, John R.
AU - Armstrong, William F.
AU - Feigenbaum, Harvey
AU - Miles, William M.
AU - Prystowsky, Eric N.
N1 - Funding Information:
From the Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine and the Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana. This study was supported In part by the Herman C Krannert Fund, Indianapolis, Indiana; by Grants HL-06308 and HL-07182 from the National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland; by the Amencan Heart AssociatIOn, Indiana Affiliate, Indianapolis, Indiana, The Veterans Administration, Merit Review Funding, Indianapolis; and The Whitaker FoundatIOn, Camp Hill, Pennsylvania. This work was completed while Dr. Windle was an Amencan College of Cardiology Merck Fellow. Dr. Armstrong is a recipient of a Clinical Investigator award from the United States Public Health Service, Washington, DC *Present address: DlVlslOn of Cardiology, University of Nebraska MedIcal Center, 42nd and Dewey, Omaha, Nebraska 68105.
PY - 1986
Y1 - 1986
N2 - Surgical and transcatheter ablation of accessory atrioventricular (AV) connections (Wolff-Parkinson-White syndrome) requires accurate localization of the accessory pathway. In a canine model of endocardial pacing, a continuous loop two-dimensional echocardiographic technique was developed for determining the earliest site of ventricular activation. This technique was then used to localize accessory AV connections in patients. Echocardiographic images were acquired on videotape and converted to a digital continuous loop format, from which the earliest site of systolic motion was determined. In six dogs, using six distinct endocardial sites, two blinded observers accurately identified the earliest site of ventricular activation in 31 (86%) of 36 and 32 (89%) of 36 locations. Determination of the earliest site of ventricular activation with the continuous loop digital technique was superior to standard analog analysis in overall accuracy (p < 0.02) and in intraobserver variability (p < 0.004). After validation of this technique, 21 patients with 22 accessory AV connections with anterograde conduction were studied. The earliest site of mechanical activity was determined during sinus (10 patients) or atrial paced (11 patients) rhythms by two blinded observers and compared with electrophysiologic mapping and surface electrocardiograms. Digitally processed echocardiograms correctly localized the earliest site of ventricular activation in 18 of 22 connections and predicted an adjacent location in the remaining 4. It is concluded that digitally processed continuous loop echocardiographic analysis accurately localizes the site of origin of ventricular activation in patients with ventricular pre-excitation associated with the Wolff-Parkinson-White syndrome.
AB - Surgical and transcatheter ablation of accessory atrioventricular (AV) connections (Wolff-Parkinson-White syndrome) requires accurate localization of the accessory pathway. In a canine model of endocardial pacing, a continuous loop two-dimensional echocardiographic technique was developed for determining the earliest site of ventricular activation. This technique was then used to localize accessory AV connections in patients. Echocardiographic images were acquired on videotape and converted to a digital continuous loop format, from which the earliest site of systolic motion was determined. In six dogs, using six distinct endocardial sites, two blinded observers accurately identified the earliest site of ventricular activation in 31 (86%) of 36 and 32 (89%) of 36 locations. Determination of the earliest site of ventricular activation with the continuous loop digital technique was superior to standard analog analysis in overall accuracy (p < 0.02) and in intraobserver variability (p < 0.004). After validation of this technique, 21 patients with 22 accessory AV connections with anterograde conduction were studied. The earliest site of mechanical activity was determined during sinus (10 patients) or atrial paced (11 patients) rhythms by two blinded observers and compared with electrophysiologic mapping and surface electrocardiograms. Digitally processed echocardiograms correctly localized the earliest site of ventricular activation in 18 of 22 connections and predicted an adjacent location in the remaining 4. It is concluded that digitally processed continuous loop echocardiographic analysis accurately localizes the site of origin of ventricular activation in patients with ventricular pre-excitation associated with the Wolff-Parkinson-White syndrome.
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U2 - 10.1016/S0735-1097(86)80148-6
DO - 10.1016/S0735-1097(86)80148-6
M3 - Article
C2 - 3711485
AN - SCOPUS:0022570564
SN - 0735-1097
VL - 7
SP - 1286
EP - 1294
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 6
ER -